Hypoglycemia Rates in the First Days of Life among Term Infants Born to Diabetic Mothers

Abstract

Objectives: To discover the risk factors for developing hypoglycemia in newborns born to diabetic mothers and to characterize the rates of glucose concentrations in the first two days of life. Methods: Retrospective recordings of medical charts of 576 healthy term infants of diabetic mothers during an 18-month period. We determined the following pre-feeding glucose concentrations: ‘normoglycemia’ (≥47 mg/dl = 2.6 mmol/l), ‘mild hypoglycemia’ (40–46 mg/dl = 2.2– 2.5 mmol/l), ‘moderate hypoglycemia’ (30–39 mg/dl = 1.7–2.1 mmol/l) and ‘severe hypoglycemia’ (<30 mg/dl = 1.7 mmol/l). Results: Glucose concentrations below ‘normoglycemia’ and ‘severe hypoglycemia’ were observed in 280 (48.6%) and 23 (4%) of the infants, respectively. The main risk factors for developing glucose concentrations below ‘normoglycemia’ in the first day of life were large size for gestational age and maternal insulin-dependent diabetes mellitus. ‘Severe hypoglycemia’ was more common among infants born to mothers who needed insulin (either type A2 or insulin-dependent diabetes mellitus). Infants born to mothers with insulin-dependent diabetes mellitus were less mature, heavier, large for their gestational age and exhibited more ‘severe and moderate hypoglycemia’ in the first day of life as compared to infants born to diabetes type A1 and A2 mothers. In addition, infants who were large for gestational age tended to have more ‘moderate hypoglycemia’ when born to diabetes type A1 mothers compared to small and appropriate-for-gestational-age infants. Thirty infants (5%) still had hypoglycemia on the second day of life. This subgroup of infants did not differ with regard to maternal-type diabetes. Conclusions: Infants born to diabetic mothers tend to have a high rate of hypoglycemia on the first day of life when a relatively high cut-off point (≥47 mg/dl = 2.6 mmol/l) is used. Infants born large for gestational age as well as those born to mothers with juvenile diabetes mellitus are at higher risk and should be closely monitored.

Effects of Passiflora edulis on the Metabolic Profile of Diabetic Wistar Rat Offspring

“…This finding indicates that maternal hyperglycemia is related to hyperglycemia or insulin resistance in the offspring when they are adults. Maayan-Metzger et al 3 showed that the main risk factors for developing hypoglycemia in the first day of life were large size for gestational age and maternal type 1 diabetes mellitus. The young offspring who were born to mothers with diabetes mellitus were heavier, large for their gestational age, and had more severe hypoglycemia in the first day of life compared with infants born to mothers with nonsevere diabetes mellitus.…”

“…Elevation of maternal glucose levels causes fetal hyperglycemia and hyperinsulinemia, leading to increased perinatal morbidity and mortality and affecting the synthesis of lipids and proteins. [2][3][4][5][6] Diabetes mellitus causes approximately 10% of fetal malformations and is responsible for 40% of neonatal deaths. [7][8][9] Live newborns may already have metabolic alterations and higher risk for future complications.…”

Gestational diabetes mellitus: Where are we now?

“…This is chiefly associated with the maternal glycemic profile [24]. ▪ Neonatal hypoglycemia occurs in 25% of newborns, and it depends on maternal glycemic control at time of delivery [25,26]. ▪ Neonatal hypocalcaemia is reported in 10-20% of infants to GDM mothers and it's related to severity of maternal diabetes [21,27].…”

Leitlinie zur Betreuung von Neugeborenen diabetischer Mütter

“…Deren Ausmaß korreliert mit der mütterlichen Stoffwechsellage; selbst grenzwertig erhöhte Blutzuckerwerte in der Schwangerschaft können mit einem erhöhten Risiko für Makrosomie, Hypo glykämie und Hyperbilirubinämie einher gehen [23,26]. Die Ausprägung der Symp tome ist abhängig vom fetalen Geschlecht -höhere Makrosomierate bei männlichen Feten [50] -und der erforderlichen Be handlungsintensität -höhere Raten post nataler Hypoglykämien bei mit Insulin therapiertem als bei diätetisch behandel tem Diabetes [41].…”